Appendage restraint and positioner

ABSTRACT

An apparatus for positioning and restraining a patient&#39;s appendage in a desired attitude during surgery includes a tray movable along a rail on the operating table. The tray extends over the patient receiving surface of the operating table and has a fastener on the upper surface which cooperates with a fastener on a wrap enclosing the patient&#39;s appendage. By adjusting the brackets along the length of the operating table rail, the patient&#39;s appendage will be flexed to a position desired by the surgeon. Locking the brackets in place retains the desired flex during the procedure. The frame of the apparatus is reusable through sterilization and the tray is provided in a sterilized condition and disposable after surgery.

BACKGROUND OF THE INVENTION

1. Field of the Invention

This invention relates to orthopedic surgery and, more particularly, to a device and method of positioning and maintaining a joint in place during surgery.

2. Description of the Prior Art

During orthopedic surgery it is very important to maintain a constant position for the patient's appendage, especially if the surgery is to replace portions of a natural joint with a prosthesis. This constant position results in the prosthesis closely fitting onto the remaining natural bones and providing a good functional equivalent of the natural joint. Some surgeons assign an operating room nurse to exclusively monitor and manipulate the position of the patient's appendage and flexure of the joint during the entire surgical procedure. The ability of the nurse to maintain the appendage depends on the nurse's strength, stamina, and ability to anticipate movement. For instance, if a knee prosthesis is the basis of the surgery then the nurse may be used to hold an individual's leg during the surgery. The nurse may also be expected to assist in the surgery which may lead to disruptions should the leg move while the nurse is attending to other functions. Clearly, this is an inefficient use of manpower and operating room resources.

Other conventional devices for supporting and restraining a patient on an operating table include U.S. Pat. No. 5,560,728 issued to McFadden which discloses a head rest mounted on a frame with arms that are attached to a bracket attached to the table; U.S. Pat. No. 5,369,827 to Parke et al which discloses foot stirrups mounted on arms held on an operating table rail; U.S. Pat. No. 5,020,525 to Ewing et al which discloses a series of straps with Velcro fasteners wrapped about an appendage and connected to a cable system attached to an operating table; and U.S. Pat. No. 4,766,891 to Schultz which discloses a belt with patient leg connectors worn by the surgeon so that, by changing position, the surgeon can dictate the position and flex of the patient's leg.

All of these devices have attachments that extend outwardly from the operating table and are subject to accidental movement of the patient's appendage because of interference with the device by operating room personnel.

What is needed in the art is a method and apparatus for positioning and restraining a patient's appendage in a fixed orientation on the surface of the operating table.

SUMMARY OF THE PRESENT INVENTION

The instant invention is an apparatus for positioning and restraining a patient's appendage in a desired attitude during surgery. The apparatus includes a tray movable along a rail on the operating table, the tray extends over the patient receiving surface of the operating table. The tray is formed from either a rigid or soft surface having hook and loop fastener which cooperates with a hook and loop fastener on a wrap enclosing the patient's appendage. By adjusting mounting brackets along the length of the operating table rail, the tray can be placed anywhere along the length of the table. Once appendage tray is positioned longitudinally along the table, based on the patient's appendage position, the tray is secured in position for the surgical procedure. The surgeon can now flex and secure the patient's appendage to the tray. Alternatively the surgeon can separate the appendage fastener from the tray fastener and flex and reposition the patient's appendage to anywhere on the tray zone that is an appropriate position.

Therefore, it is an objective of this invention to provide a method of fixing a joint at a desired degree of flexion/rotation, during the surgical procedure, with the ability to reposition the patient's appendage anywhere in the tray zone throughout the surgical procedure.

It is another objective of this invention to provide an apparatus for attachment to a conventional operating table for adjustably supporting a patient restraint on the surface of the table.

It is a further objective of this invention to provide a patient wrap for fitting about an appendage and connecting with a patient restraint on an operating table.

Still another objective of the invention is to provide a frame that can be sterilized through various means such as an autoclave and have disposable drapes, that is, patient wrap and tray which is in sterilized condition prior to use and disposable after surgery

Other objectives and advantages of this invention will become apparent from the following description taken in conjunction with the accompanying drawings wherein are set forth, by way of illustration and example, certain embodiments of this invention. The drawings constitute a part of this specification and include exemplary embodiments of the present invention and illustrate various objects and features thereof.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a perspective of the operating table accessory of this invention;

FIG. 2 is a side view of the operating table accessory of this invention;

FIG. 3 is a perspective of the bracket and clamp of this invention;

FIG. 4 is a perspective of the frame, support and tray of this invention;

FIG. 5 is a perspective of the frame adjustment device of this invention;

FIG. 6 is an exploded view of the frame and adjustment device;

FIG. 7 is a perspective of a wrap of this invention;

FIG. 8 is an exploded perspective view of the self sustaining plate embodiment; and

FIG. 9 is a side view of FIG. 8.

DETAILED DESCRIPTION OF THE INVENTION

The surgical operating table 10 has a patient receiving surface 11 and a longitudinal rail 12 extending along the longitudinal edge of the table. The operating table accessory 13 is slidably and adjustably mounted on the rail 12 by brackets 14 and 16. As shown in FIG. 1, the brackets 14 and 16 are identical separate elements however, they may be united as one elongated bracket with one or more clamps. The bracket 14 has a clamp 15, shown in FIG. 2 and FIG. 3, having a hinge 17 and a lock screw 18. The lock screw 18 cooperates with screw threads in the slot 19 to tighten and loosen the clamp, as desired to the rail. The tightening of the lock screw 18 forces the bracket flanges 20, 21 away from the rail 12 securing the bracket in place.

The brackets 14 and 16, sown in FIG. 1, have identical supports 22 and 23, respectively, which extend upwardly from the brackets toward the patient receiving surface of the operating table. The supports are telescoped in the brackets 14, 16 so that the height of the supports may be adjusted. The bracket 14 has a vertical clamp 24 with a bore 27, shown in FIG. 3, for holding the support. A locking screw 28 screws into the body of the bracket and changes the diameter of the bore 27 to lock the height of the support. The supports have curved arms 25, 26 extending over the patient receiving surface of the table.

The arms 25, 26 form end portions of a frame 30 which includes a longitudinally adjustable stretcher bar 31 which is connected to the free ends of the arms. As shown in FIG. 4, a flexible material 32, such as a woven, knitted, or nonwoven fabric or film is suspended between the arms 25, 26 and the stretcher bar 31 of the frame 30 forming a tray 33. The material 32, the supports, arms and stretcher bar may be made as a disposable tray 33 or the material 32, only, may be removed from the frame. As shown in FIG. 5 and FIG. 6, the stretcher bar 31 is of two piece construction with an upper bar 37 and a lower bar 38 slidably fitted together. The linear actuator 36 has one end 39 attached to one bar and the other end 40 attached to the other bar. As shown in FIG. 5, the end 39 rotates in a journal 40 on bar 38 and the other end 41 has a screw threaded bore 42 fixed to bar 37. A jack screw 43 extends through the bore and fits in the journal to lengthen or shorten the distance between the ends by turning the jack screw. In FIG. 6, the ends of the upper bar 37 and the lower bar 38 are shown with a receptor 44 and 45, respectively, which removably slide onto a post 46 on the free ends of the arms 25, 26.

The material 32 has a tunnel hems 34, 35 at opposite ends through which the arms 25, 26 are inserted. Once the arms are in the hems, the stretcher bar is adjusted by the linear actuator 36 to make the material taunt. The material 32 has a fastener 47 on the upper surface which, in the preferred embodiment, is one component of the hook and loop fastener “Velcro” though other fasteners, such as snaps, ties, buttons, adhesives, etc. could be employed. As an alternative, the material may be a self sustaining plate with the fastener laminated to the upper surface. FIGS. 8 and 9 depict the use of a self sustaining plate formed from a rigid material with the fastener 64 placed within a frame 62. Positioning fastener 68 insertable into aperture 71 for attaching to mounting hole 70 placed in arms 25 and 26. The arms are insertable into the plate providing a smooth surface to allow ease of appendage placement.

Further, the tray 33 including the supports 22, 23, the arms 25, 26, the stretcher bar 31 and material 32 could be molded or otherwise formed as a unitary component with the fastener. The arms would not require adjustment and the entire tray would be disposable.

A wrap 50 is used to enclose an appendage of a patient. As shown in FIG. 4 and FIG. 7, the wrap 50 is in the form of a bootie but other configurations for the hand, ankle, or elbow may be supplied with the apparatus. The wrap has a corresponding fastener 51 which cooperates with the fastener 47 to fix the appendage to the tray 33. The bootie has an upper 52 that wraps around the foot with a closure 53.

In preparing for a knee replacement, for example, the wrap 50 would be placed on a patient's foot. With the patient on the receiving surface of the operating table, the brackets would be adjusted along the operating table rail to an approximate desired position. The patient's foot and wrap would be fastened to the fastener on the tray. The brackets could then be finally adjusted to place the knee in the proper attitude for the operation and locked in place for the surgical procedure. The patient's foot and wrap would be fastened to the fastener on the tray. The entire tray zone can be used for securement of the appendage to the tray.

The apparatus provides a method of orthopedic surgery for use on a surgical table having a patient receiving surface and a side rail extending along the side of the table. The apparatus of the invention includes an adjustable bracket that is adapted to the side rail, the bracket having a clamp for temporarily securing the bracket at a desired location along the rail. A support extends upwardly from the bracket toward the patient receiving surface. The tray is coupled to the bracket by a frame. The tray has a restraining surface including at least a portion covered with a hook and loop fastener. A appendage wrap is provided for enclosing a portion of a patient's appendage, the wrap having a fastener on a surface thereof cooperating with the tray located fastener. The patient is placed on the table and a portion of an appendage is covered with the wrap. The position of the appendage is placed in the desired surgical position which places the joint to be operated on in the desired surgical position. The frame is reusable through sterilization and the drape material is provided in a sterilized condition and disposable after surgery.

A number of embodiments of the present invention have been described. Nevertheless, it will be understood that various modifications may be made without departing from the spirit and scope of the invention. Accordingly, it is to be understood that the invention is not to be limited by the specific illustrated embodiment but only by the scope of the appended claims. 

1. A method of orthopedic surgery comprising the steps of a) providing a surgical table having a patient receiving surface and a side rail extending along a long side of said table, b) providing an adjustable bracket adapted to slidably mount on said rail, said bracket having a clamp for temporarily securing said bracket at a desired location along said rail, a support extending upwardly from said bracket toward said patient receiving surface, c) slidably connecting said bracket to said rail, d) providing a tray having a restraining surface and a frame supporting said tray, e) connecting said frame to said support, f) providing a wrap for enclosing a portion of an appendage of a patient, said wrap having a fastener on one surface, said fastener cooperating with said restraining surface to fix said restraining surface and said wrap together, g) placing a patient on said patient receiving surface of said table, h) covering a portion of an appendage of the patient with said wrap, i) adjusting the position of said appendage to place a joint in the desired surgical position and j) fixing said fastener of said wrap and said restraining surface together, and
 2. A method of orthopedic surgery of claim 1 comprising the steps of a) providing said frame with a first arm and a second arm, said first and second arms being parallel with said patient receiving surface and spaced apart along said rail, b) providing said tray with a first connector at one end and a second connector at the other end, c) mounting said tray on said frame by attaching said first arm to said first connector and said second arm to said second connector whereby said tray is supported between said first and second arms over said patient receiving surface.
 3. A method of orthopedic surgery of claim 1 comprising the steps of a) providing said restraining surface with a first releasable adjustable fastening means for fixing a patient's appendage to said restraining surface, b) providing said wrap with a second cooperating releasable adjustable fastening means for fixing said wrap to said restraining surface, and c) joining said first fastening means with said second cooperating fastening means to fix said patient's appendage to said restraining surface.
 4. A method of orthopedic surgery of claim 3 comprising the steps of a) providing said first releasable fastening means with a flexible material having a series of loops, b) providing said second cooperating fastening means with a flexible material having a series of hooks, and c) placing said loops in contact with said hooks to engage said loops and said hooks for fixing said first fastening means and said second cooperating fastening means together.
 5. A method of orthopedic surgery of claim 4 comprising the steps of a) providing said frame with a first arm and a second arm, said first and second arms being parallel with said patient receiving surface and spaced apart along said rail, b) providing said tray with a first connector at one end and a second connector at the other end, c) mounting said tray on said frame by attaching said first arm to said first connector and said second arm to said second connector, d) providing said restraining surface with a flexible material, said flexible material having a first tunnel hem at one end and a second tunnel hem at said other end, and e) sliding said first and second arms in said first and second tunnel hems, respectively whereby said tray is supported between said first and second arms over said patient receiving surface.
 6. A method of orthopedic surgery of claim 4 comprising the steps of a) providing an adjustment means on said frame between said first arm and said second arm for changing the space between said first arm and said second arm to accommodate said first connector and said second connector, b) adjusting said first arm and said second arm to engage said first tunnel hem and said second tunnel hem, respectively, and c) sliding said first arm in said first tunnel hem and said second arm in said second tunnel hem.
 7. A method of orthopedic surgery of claim 1 comprising the steps of a) providing said bracket, said clamp, said support, said frame and said restraining surface as an integral disposable component, b) providing said wrap with an integral fastener, said wrap being disposable, b) performing a surgical procedure on said patient's appendage, c) removing said patient, and d) disposing of said integral wrap and said integral bracket, said clamp, said support, said frame and said restraining surface.
 8. An apparatus for positioning and holding a patient's appendage in place on an operating table during a surgical operation comprising the combination of an operating table accessory and a patient wrap, said accessory including a bracket adapted to slidably engage said operating table for adjustment longitudinally along said table, a clamp on said bracket for securing said bracket in a preselected longitudinal position, a support mounted on said bracket and adapted to extend from said bracket toward the operating surface of said operating table, a tray secured to said support and adapted to extend over the operating surface of said operating table, a restraining surface on said tray, said wrap including a covering for an appendage of a patient, a fastener on said covering, said fastener adapted to cooperate with said restraining surface to fix said wrap and said restraining surface together whereby the appendage is fixed to said restraining surface by said wrap and the location of said appendage is adjustable by sliding said bracket along the operating table.
 9. An apparatus of claim 8 comprising said tray having a self supporting planar substrate and said restraining surface is attached to one surface of said planar substrate.
 10. An apparatus of claim 8 comprising said restraining and said fastener formed of cooperating separable components of Velcro.
 11. An apparatus of claim 8 comprising said tray formed of a flexible material having a first tunnel hem at one end and a second tunnel hem at the other end, said frame having a first arm and a second arm, said first arm and said second arm inserted in said first tunnel hem and said second tunnel hem, respectively.
 12. An apparatus of claim 11 comprising an adjustment means on said frame for changing the distance between said first arm and said second arm. 